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STRATEGY FORMULATION FOR HOSPITALS IN REMOTE AREAS: CASE STUDY OF X HOSPITAL, WEST BORNEO PROVINCE, INDONESIA, 2019
Get PDFBackground: Located in remote area, X Hospital is facing various challenges as a private non-profit class C hospital. Therefore, it needs to develop an appropriate strategic plan for the year 2020-2024 to overcome challenges and achieve its vision. This study is aimed at identifying the strengths, weaknesses, opportunities and threats from internal and external strategic factors, determine strategic positioning, and formulate alternative strategies for X Hospital.
Method: This is a preliminary study with qualitative - exploratory design. Data were collected through in-depth interviews, group discussions and observation. The interviews were conducted with 7 key informants holding strategic management positions. This study was conducted in two in-depth stages using Consensus Decision Making Group (CDMG) method to avoid bias. Data were analyzed using Internal Factor Evaluation (IFE) and External Factor Evaluation (EFE) matrixes at the input stage and Internal External (IE) and Threat Opportunity Weakness Strength (TOWS) matrixes at the matching stage. This study was conducted at X Hospital, West Borneo Province, Indonesia, from March to April 2019.
Results: The IFE final score was 2.38 with strength (1.68) greater than weakness (0.70) and EFE score of 2.16 with threats (1.10) greater than opportunities (1.06). Such input stage results indicate that X Hospital has average response in utilizing its internal and external strategic factors where strengths are more prominent than weaknesses but the threats are still overshadowing its opportunities. Consequently, the results of matching stage place X Hospital on the position of hold or maintain strategies and formulate 11 alternative strategies that focus on market or product development.
Conclusions: X Hospital is currently on a strategic position to develop its services as the basis for the five-year strategic planning. A new policy should be made to encourage the establishment of a network with private hospitals to promote healthcare in remote areas.
Keywords: strategic plan, remote area, hospital, IE matrix, TOWS matri
FACTORS AFFECTING THE COMPLIANCE AND UTILISATION OF ANTENATAL CARE (ANC) IN BOTH HIGH INCOME COUNTRIES AND LOW-MIDDLE INCOME COUNTRIES: A SYSTEMATIC REVIEW
Get PDFBackground: Every pregnancy has its own risk related to unwanted complication. ANC or antenatal care is a program to help the improvement of both pregnancy experience and ensure the health of a baby. ANC itself has been practiced since 100 years ago, a heritage process from the European community, which facilitates pregnant women during the pregnancy to have 12 visitations to nearby health facility. However, reasoning behind such intervention was unknown. As time goes by, many researches, evaluation, and review have been done regarding the content of visitations, amount of attendance each pregnant women need to do during pregnancy period, and further outcome of ANC program. This review is done to clarify ANC program throughout countries with high, middle and low income in the world and gather knowledge from such experience.
Methods: Review was done by using databases such as PubMed, Springerlink, and proquest with keyword factors related to utilization of ANC as intervention and mother's compliance, years of publication and PRISMA method.
Results: Out of all 33 articles obtained, 12 articles were chosen as other article did not comply to the selection criteria such as year of publication and the content. Variations among different countries in such studies occurred in factors such as the program itself, subject compliance towards the study, and the number of attendees. Furthermore, technologies such as instant messages and internet was also utilized in some programs. Among many factors related to the utilized and compliance of pregnant mother, each country policies, lifestyle, education level, and family incomes played a major role in such differentiation. Furthermore, perception of mother towards the program will also affect her motivation.
Conclusion: Although the implementation of ANC in many countries still varies, there were many positive evidences to support the utilization of ANC. Surrounding communities could implement the program if it is suitable to the individuals. Monitoring and evaluation of such program also need to be done.
 
THE ACCURACY OF DIAGNOSIS, PROCEDURES AND CODING COMPLETENESS AND THEIR CORRELATION WITH INA-CBG CLAIMS
Get PDFBackground: Since 1 January 2014, the INA-CBG system has been applied as a method of payment for outpatient and inpatient services. Indonesian-Case Based Groups (INA-CBG) tariff is the amount of payment claimed by the Health Social Security Administering Agency (BPJS) to the hospitals for a package of services based on the classification of diagnoses and procedures of diseases. The inequality in the number of claims received by the hospital compared to the resources used will be unbeneficial to the hospital. The purpose of this study is to identify the correlation of incompleteness and inaccuracy of diagnosis, procedures, and coding to the number of INA-CBG claims at hospitals in Indonesia.
Method: The research method is the literature review. The authors found five articles cited by Google Scholar published in journals and two theses taken from the Library of Universitas Indonesia that include ”factors that influence INA-CBGs claim amounts at hospitals” or related concepts in the title or abstract. Articles and theses published from 2014 to 2018 were search using the following terms in the title or abstract: "accuracy, completeness, diagnosis, coding, INA-CBG claims.”.
Result: The authors found seven articles that met our criteria: Two studies used qualitative approach, three studies were quantitative studies, two studies used a mix method. From these studies, there were five practical considerations that were considered as the factors that influenced the number of INA-CBGs claims at hospitals in Indonesia: completeness of filling a medical resume, accuracy of coding, accuracy in filling medical resumes, the accuracy of information systems, and completeness of claim administration document.
Conclusion: The study has indicated the factors that influence the amount of INA-CBG claims in hospitals in Indonesia, mainly, the factor of completeness of medical resumes and the factor of accuracy in coding by the coders. The completeness of a medical filling resume which is highly dependent on physician compliance and accuracy coding. All the human resources who have a role in coding and claims, need to improve their capability on it, through a workshop, or any other education funded by the hospital. Coder certification must be done. Hospital has to develop hospital management information system for acceleration in coding and claim.
 
Determinants of condom use status among men who have sex with men (MSM) group in 5 Indonesian cities in 2015
Get PDFBackground: Significant increase in HIV cases among men who have sex with men (hereafter MSM) group during the 2015-2016 period confirmed that sexual behavior is a major risk factor in exposure to HIV & AIDS with unprotected sexual intercourse as the dominant risk factor. This study aims to identify the determinants of condom use status among MSM group in 5 cities in Indonesia.Methods: This study used a cross sectional design, carried out in 5 cities in Indonesia: Jakarta, Bandung, Semarang, Surabaya, and Denpasar using secondary data from the Integrated Biological and Behavioural Survey (IBBS) in 2015.Results: Variables that are significantly related to the condom use status were marital status, exposure to information on HIV&AIDS, and knowledge about condoms. The marital status variable has a POR value of 1.351 (95% CI OR 0.709 í¢AS 2.576), whilst exposure to HIV&AIDS information has 1.668 (95% CI OR 1.148 í¢AS 2.422) POR value, and knowledge about condoms has POR value as much as 1.925 (95% CI OR 1.274 í¢AS 2.907).Conclusion: The number of respondents who used condoms consistently for the past one month were 76.1% and those who did not were 23.9%. Variables that are significantly related to the behaviour of not using condoms are marital status, exposure to HIV&AIDS information, and knowledge of condoms.
Keywords: Determinants, Behavior, Condom, MSM, HIV&AIDS
Received: 12 March 2019; Reviewed: 16 April 2019; Revised: 26 April 2019; Accepted: 30 June 2019
DOI: 10.35898/ghmj-3254
The effect of chocolate consumption (Theobroma cacao L.) on level of blood cholesterol and triglyceride in hypertension patients at Jatiroto Health Center, Indonesia
Get PDFBackground: Hypertension is influenced by lifestyle factors such as high fat intake which has the potential for high blood cholesterol level. Cocoa products, which are rich sources of flavonoids, have been shown to reduce blood pressure and the risk of cardiovascular disease.Aims: The purpose of this research is to examine the dark chocolate consumption in decreasing the level of blood cholesterol and triglyceride in hypertension patients.Methods: This research is a quasi-experiment study with pre and post and control group design. There were thirty two (32) hypertensive patients selected from Jatiroto Health Center in June-July 2018 using a random sampling technique. The respondents were then divided to (1) a control group where patients were prescribed to a popular non-pharmacological therapy Simvastatin and (2) an intervention group where the respondents were prescribed with Simvastatin and also received an additional dark chocolate 60gr/day (given twice a day, each 30gr) for 15 days. A spectrophotometer glycerol phosphate oxidase (GPO-POD) with 546 nm wavelength was employed to measure the levels of blood cholesterol and triglyceride. The significant mean difference between pre and posttest, and the changes between control and intervention group were defined by statistical analysis T-test.Results: This study acknowledged that the prescribed simvastatin alone presents a significant contribution to decrease the cholesterol level at 14.40 point (p value = 0.041), however, the generic is not enough to deliver a significant effect to the decrease of triglyceride level in the hypertension patients (p value = 0.361). A great contribution to the depression of cholesterol and triglyceride level in the hypertensive respondent was observed if simvastatin prescription was combined with a provision of 60 gram dark chocolate, respectively to the level of 57.06 and 38.41 mg/dL with p value = 0.001. The addition of dark chocolate in the simvastatin prescription will significantly reduce the blood cholesterol level (p value = 0.020), but not really effective to reduce the triglyceride (p value = 0.560).Conclusion: The findings suggest that giving dark chocolate to the hypertensive patients who receive simvastatin prescription will decrease the cholesterol and triglyceride levels greater than the consumption of simvastatin drugs alone.
Keywords: Dark chocolate, Simvastatin, Hypertension, Cholesterol, Triglyceride
Received: 25 August 2018, Reviewed: 04 September 2018, Received: in revised form 23 February 2019, Accepted: 26 February 2019
DOI: 10.35898/ghmj-3155
Critics on Policy of Soy-Based Infant Formula in Indonesia: Compared to Australian and New Zealand Food Standards
Get PDFBackground: World Health Organization (WHO) recommends breast milk as sole and the most complete infant food during the first 6 months. However, in certain circumstances, when breastfeeding is not possible, not desired or not advised, infant formulas like those are made of soy can be given to newborns. However, the safety of long-term use soy-based formula has been argued due to the possible adverse effects of phytoestrogen, phytates and aluminum in human body as well as the consequences of agrochemicals residue. Therefore, those problems should be taken into account while developing, reviewing or amending policy of infant formulas. This article reviews the adequacy of soy-based infant formula policy in Indonesia to anticipate issues in SIF consumption.
Methods: Australian and New Zealand Food Standards Code was used to compared to the decree of Indonesian NADFC. The results were described narratively and analyzed from the perspective of the author.
Results: Accordingly, only small aspects of SIF are regulated in Indonesian policy. The use of SPI for SIF in Indonesia is not a compulsory though scientifically another source may trigger diarrhea in newborn baby. No clause related to aluminum content, zinc to copper ratio, isoflavone level, GM soy and pesticide residue found in Indonesian policy.
Conclusion: Apparently, very limited provision regarding SIF has been covered by Indonesian policy. The regulation of SIF marketed and manufactured in Indonesia should be more specific and developed based on recent clinical and epidemiological studies. On the other hand, Indonesia needs a comprehensive system where society may participate in reviewing the laws.
Keywords: soy-based infant formula, food policy, food standards
Received: 14 May 2019 Reviewed: 18 June 2019 Revised: 1 July 2019 Accepted: 6 July 2019
DOI: 10.35898/ghmj-3358
FAMILY PLANNING FIELD WORKERS' EXPECTATIONS AND PERCEPTIONS ON SERVICE QUALITY OF TRAINING AND EDUCATION AT NATIONAL POPULATION AND FAMILY PLANNING BOARD IN PROVINCE OF CENTRAL SULAWESI, INDONESIA
Get PDFBackground: Training and education for employees are the important thing to develop their knowledge, skill, performance as well as career. It is important to improve the quality of training and education service in National Population and Family Planning Board (BKKBN), specially training and education for field workers. Performance achievement of family planning field workers in province of Central Sulawesi until November 2018 was low, it was only 57,8% from 95% as a target for a year even though BKKBN province of Central Sulawesi implemented 10 training and education to them for improve the performance. This study aims to compare between trainees expectations and perceptions of service quality and then set up the guidelines to improve the trainig and education for family planning field workes at National Population and Family Planning Board, Province of Central Sulawesi, Indonesia.
Method: This research method uses quantitative and qualitative with desciriptive design. 169 respondents filled the questionnaire with 22 statements which was pertaining with five dimensions of service quality (tangible, reliable, responsive, assurance and empathy). Moreover, focus group discussion has been used as one of qualitative methods with the management of BKKBN as participants who conduct the training and education.
Conclussions: Level of expectation is in the highest level and level of perception in the highest level. Trainees expectation beyond their perceptions means that trainees did not satisfy with training and education, because perception was related with satisfaction. There was a significant differences between expectations and perceptions for tangible, reliability, responsive and assurance (p<0.05). All dimension had negative gap between expectations and perceptions (SQ= P-E). According to this gap, organiser who conduct training and education may be able to find the problem solving to improve the quality and reducethe gap between trainees expectations and perceptions and make the guidelines.
Keywords: Service quality, Expectations, Perceptions, Family Planning Field worke
THE CORRELATION OF ADOLESCENT'S KNOWLEDGE AND ATTITUDE TO DRUGS WITH ADOLESCENT'S DRUG ABUSE BEHAVIOR IN THE COMMUNITY HEALTH CENTER OF KESUNEAN, CIREBON
Get PDFBackground: The reports on the number of drug abuse in Indonesia by the National Narcotic Agency (NNA) showed 3.3 million drug users in 2008 and 3.8 million drug users in 2014 in which its number keeps increasing year after year. The number of teenagers who become drug users in Cirebon is quite high, i.e. 25% compared to unemployed people of 19%, and followed by private employees and government employees of 56%. Data from community health center show that drug users who underwent treatment and were sent to rehabilitation center in 2017 were 32 people; it was higher than in 2016, i.e. 10 people. Adolescence is a transition period between childhood and adulthood. There are several factors influencing mental abilities, knowledge, and attitudes. It makes adolescents may consume narcotics, psychotropic abuse and other drug addictive substances. The community health center of Kesunean has an Integrated service post (ISP) program called REMPONG PISAN (an ISP who cares for HIV/AIDS and Narcotics) aiming to make adolescent understand about HIV/AIDS and drugs and to make them healthy. This ISP program is conducted once a month with one of the activities is education about HIV/AIDS and drugs. Aim: To observe the correlation of adolescent's knowledge and attitudes to drugs with drug abuse behavior among adolescents at the ISP.
Method: This research was an observational analytic study with a cross-sectional design. The sample was determined using consecutive sampling technique during the implementation of the ISP at the 2 neighborhood in the community health center of Kesunean. The data were analyzed using Pearson correlation to determine the correlation of adolescent's knowledge and attitudes to drugs with drug abuse behavior among adolescents.
Results: Statistical analysis shows that there was no significant correlation between knowledge and drug abuse behavior (p = 0.180 and; r = -0,201), there was no significant correlation between attitudes with drug abuse behavior (p = 0.264; r= -0,168), however, there was a significant correlation between knowledge and attitudes towards drug abuse (p = 0.000; r = 0,710**).
Conclusion: The better the adolescent's knowledge about drugs, the better their attitude will be. In this case, good teen behavior is influenced by good knowledge and attitude.
Keywords: NNA, Drug, Knowledge, Attitude, Drug Abuse Behavio
DOES BEETROOT JUICE LOWER BLOOD PRESSURE?: A SYSTEMATIC REVIEW
Get PDFBackground: Hypertension or high blood pressure has been a common global health problem for several years. The content of nitrate within beetroot helps to increase production of nitric oxide (NO) which serves as a vasodilator and has potency to reduce blood pressure. This study aims to determine the potential effect of beetroot juice on reducing blood pressure.
Methods: This study was a systematic review based on the PRISMA protocol as a writing guideline. Data were obtained from PubMed, Science Direct, and Google Scholar databases. Keywords used consisted of "beetroot”, "beetroot juice”, "blood pressure”, and "hypertension.” The eligibility criteria were research written in English, years of publication from 2014 and above, and Randomized controlled trials of beetroot juice interventions on reducing blood pressure.
Results: The literature search resulted in 376 records, and only 9 studies were in the systematic review. Six out of 9 studies showed significant results of blood pressure reduction, but the other three studies confirmed otherwise. A significant reduction of blood pressure was mostly observed in healthy subjects. The efficacy of beetroot juice supplementation is influenced by several factors, including gender, age, nutritional status (BMI), initial blood pressure, duration of supplementation, dose, and concentration of nitrate.
Conclusions: Beetroot juice supplementation is not so useful on reducing blood pressure because it only has an acute effect in lowering blood pressure and its effects were also influenced by several factors.
Key Words: beetroot juice, blood pressure, hypertension, a systematic revie
USING SCORECARD TO ANALYSE RISK FACTORS OF STROKE IN WEST SUMATERA INDOENSIA
Get PDFBackground: Stroke is one of the most frightening diseases because it may cause major deaths in Indonesia. Recently, it has caused the death for about 21.1% of all ages. The World Health Organization (WHO) predicts that deaths caused by stroke will increase”every 45 seconds a person has a stroke, and”every 4 seconds there is a death caused by stroke. At this time, there is a shift in the phenomenon; stroke does not only suffer the elderly patients, but it has now attacked the productive age or young age also.The purpose of this study was to identify the proporsion of risk of stroke in productive age of Bukittinggi populationbased on Risk Scorecard.
Method: The study used a survey analytic study design with approach cross-sectional. This was a population – based survey of adult households in Indonesia is about 24130 individu. The sample of this study was 322 respondents where they were taken by using simple random Sampling technique. The subjects were visited at their homes for recruitment and data collection. In each household, one or more eligible subject above the age of 18. The subject were exclude if they were mentally unable to answer thequestionnaire, were not a resident in Bukittinggi, or directly declined to participate.
Result: Individuals at high risk of stroke are 20.5%, 22.4% in case of caution, and 57.1% respondents at low risk of stroke. The results of this study represent the risk of stroke with the highest frequency of distribution was in low risk respondents. It was then followed by caution respondents. The lowest frequency was scored for high risk respondents.
Conclusion: The proportion of stroke of risk found in the productive age population of Bukittinggi that were based on risk scorecard.
Keywords: Proportion, Stroke Risk, Individuals at ris